Multimodal Intervention Reduces Opioid Use Among Hospitalized Patients With IBD

A multimodal intervention that encourages the use of nonopioid analgesics for hospitalized patients with inflammatory bowel disease (IBD) and pain is associated with reduced opioid exposure, according to a study published in The American Journal of Gastroenterology.¹

Opioid use in patients with IBD is associated with increased mortality.¹ Previous interventions targeting reduced intravenous opioid exposure for all patients admitted to a general medical unit have demonstrated decreased total opioid use without compromising pain control.² Researchers for the current study performed a prospective evaluation of a multimodal intervention encouraging the use of nonopioid alternatives to reduce intravenous opioid exposure among patients hospitalized with IBD.¹

The 4 interventions devised to decrease intravenous opioid use were implemented in stages during the study period and included an IV acetaminophen protocol, a gastroenterology consult note “smartphrase,” an IBD pain management pathway, and automated text message alerts.

This study population included 345 patients with IBD with similar baseline characteristics in both the preintervention (n=241) and intervention (n=104) periods. Investigators found that between study periods, there was a significant reduction in the proportion of patients receiving intravenous opioids (43.6% vs 30.8%, P =.03) and total opioid dose exposure (15.6 vs 8.5 intravenous morphine milligram equivalents/d, P =.02). They also observed similar mean pain scores (3.9 vs 3.7, P =.55), significantly reduced mean length of hospital stay (7.2 vs 5.3 days, P =.03), and reduced 30-day readmission rates (21.6% vs 11.5%, P =0.03).  

Study limitations include the observational nature, the lack of random assignment of patients to interventions, and the greater proportion of women in the preintervention cohort compared with the intervention cohort. Larger studies are needed to evaluate the benefit and safety of the recommended nonopioid analgesics.

“A multimodal intervention that encourages providers to use nonopioid analgesics is associated with decreased inpatient opioid exposure,” the researchers concluded.¹ “Reducing inpatient opioid exposure does not worsen pain or adversely affect hospitalization outcomes for patients with IBD.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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References

1. Dalal RS, Palchaudhuri S, Snider CK, et al. A multimodal intervention using nonopioid analgesics is associated with reduced intravenous opioid exposure among hospitalized patients with inflammatory bowel diseases. Am J Gastroenterol. 2020;115:1474-1485.

2. Ackerman AL, O’Connor PG, Doyle DL, et al. Association of an opioid standard of practice intervention with intravenous opioid exposure in hospitalized patients. JAMA Intern Med. 2018;178:759–63.